There’s a Role for All of Us in Helping Low-Income People Enroll in Health Coverage under the ACA

This month, January 2014, marks a major milestone in Americans’ access to health care. As key parts of the Affordable Care Act (ACA) became effective on January 1, millions of individuals gained health insurance coverage from the plans they chose in late 2013 —through the Health Insurance Marketplaces or the Medicaid expansion.

Let’s stop for a moment to think about what this milestone means for low-income people. For some (like a Head Start mother I met recently at a conference), coverage means they can finally see a doctor for the persistent pain, or worrisome lump, that they’ve been trying not to think too much about for years. For others, it means they can let their child play sports at school without worrying that a broken arm would mean not being able to pay the rent. For still others, it might mean seeking treatment for serious depression that has left them unable to keep a stable job or be the kind of parent they want to be.

But we only have a moment to cheer what’s been accomplished so far, because there is still so much work to be done. Millions who could be benefiting from health insurance don’t have it yet, and millions more who are enrolled need to be connected to high-quality health care if we are to ensure the full promise of the ACA.

So let’s do it. Advocates, stakeholders and state human services officials who care about poor people, children and families, and youth can -- and should -- play a central role in helping more people get and use health coverage through the ACA.

In this post, we focus on concrete steps you can take to help those who are not yet enrolled get coverage – more on using coverage to get quality care in a future post. Here’s what you can do now:

Provide accurate information about how to enroll to individuals and families you work with – and make sure they know it’s not too late to apply for coverage. (March 31st is the deadline for purchasing health insurance through the Marketplaces, unless circumstances change for reasons such as marriage, divorce, birth or adoption of a child, or loss of a job. Medicaid has no deadline.) Learn all the facts about enrollment and also the opportunities it opens up – for example, coverage for preventive services, mental health, and substance abuse treatment.

Learn about the provisions that are most important to the low-income individuals you work with. For example, if you work with youth, you need to know about the new provision requiring states to cover youth who have aged out of foster care under Medicaid until they are 26. There is no income or assets test for these youth, and this requirement applies whether your state has taken the Medicaid expansion or not.

Know which organizations in your community are providing support to assist with application, selection of plans, and enrollment (and consider adding your organization to the list if your state offers the opportunity). The past three months have shown that many individuals will need phone or in-person help in order to make their way through the enrollment process.

If your state has not taken up the Medicaid expansion, find out who is leading the effort to change that and how you can help. In states that do not take up the option, an estimated 4.8 million poor adults will face a catch-22 – they earn too little to be eligible for coverage under the Marketplace, yet they are not eligible for current state Medicaid coverage. States can expand coverage with the federal government paying 100% of the cost for the next three years and phasing down to 90% after that. Many organizations that work on issues of unemployment, early childhood education, family support, youth engagement, child welfare, and anti-poverty policy have information to share and stories to tell about the implications for poor people when they have no health insurance.

Work with state advocacy partners and state officials to provide any information you encounter about unintended problems, such as IT glitches, that could interfere with enrolling in health care. State officials need to understand the challenges poor families and individuals are facing.

This is an exciting moment for the health and wellbeing of low-income people. And there is a role for all of us in ensuring that as many people as possible get access to coverage under the ACA. Please consider taking the steps we suggest to help those you serve.